Sessions
by BankyB
Summary: Notes by Carter's therapist when he was in rehab.


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Sessions 

Dr. Burton: 

    First of all, thank you for taking time out of your busy schedule to talk to me the other day. As I mentioned to you, here are the materials on the case I'm interested in writing up and submitting to Dr. Andersen for the Journal. I've included my in-session notes as well as my post-session commentaries. (I have also enclosed a Xerox copy of the patient's signed consent form, as you requested, so there shouldn't be any future misunderstandings this time around.) I've also taken the initiative to include a few other written materials relating to my patient which you may find worthwhile. 

    Again, thanks so much for agreeing to review this. I really appreciate this opportunity to get your opinion. 

  


**5/24/00 session**

_     Notes: Intro session. Took history. J is an IV narc + presc abuser, since @4/01/00 (exact date not recalled). Tyl 4, Tyl 3, Tyl 2, fentanyl. Occ: ED 3YR at Cook County Gen, Chicago (at facility 6 yrs). NOTE: currently on presc Tyl 2 for traumatic back injury, pending switch to ibuprofen per Dr. F's instructions. Discussion of range of treatment available and referral to on campus support group for any questions about med license issues. Demeanor seems anxious/rushed, I suggest we meet next time later in afternoon time slot. J admits he has overused his presc meds. This led to discussion of 2/14 incident (ref Admit Sheet) and began PTSD screening process but ran out of time. 

    Follow-ups: Possible candidate for taping? ask next time. 

_     My comments: This was your typical introductory getting-to-know you Q&A. John readily supplied information about the prescription medications he was using for his back injury and talked openly about overmedicating, but did not comment much when I asked him about the fentanyl use. He touched on this relating to the "complaint" that a co-worker had made about "my behavior in trauma" but didn't elaborate. We discussed his attack and injuries on Valentine's Day: he and a co-worker had been awaiting a psychology consult for a patient in an isolated area of the ED when the patient had a psychotic break and attacked both of them with a large knife, wounding both seriously. His co-worker died in surgery. [See enclosed clippings from the Chicago Tribune.] 

    John seemed to me to be a good candidate for videotaping. He was articulate, open and personable, although currently a little inhibited (of course, not surprising for a first meeting). 

  


**5/26/00 session**

    _Notes: Continuing PTSD screening questions and more discussion of 2/14 attack by patient in ED. J says he has discussed this with psych staff member at his facility earlier but there was no time and he was not ready. NOTE: no counselors made available for staff at CCG. J had a temporary colostomy and used crutches for 4 wks. still experiencing significant residual pain. J rated his current pain level 7 on a scale of 10. Staying w/grandparents in town. I feel J has mild PTSD but is recovering however there appear to be unresolved issues w/Lucy- med student murdered. Not the best relationship - J expressed some regret at encounter with Lucy's mother after the attack. Discussed teaching methods w/Lucy. J likes teaching groups of students but has felt ineffective, inadequate with one-on-one teaching relationships. Would like to teach in future but feels he will not be permitted to supervise students again. J then agreed to sign consent form for taping of sessions w/permission for playing in classroom, and research use of edited transcripts. _

    Follow-ups: Does CCG have outside counselors available for staff after violent events/colleague deaths? staff may not feel comfortable receiving counseling from colleagues? more staff problems arising from this incident? COS is Robt Romano. 

    Also re-read chapter in Heseltine on counseling of male victims of physical and/or sexual assault. 

    My comments: Our discussion of the events surrounding and leading up to his attack made it clear that John needed to do more grief work relating to his student, Lucy, and probably also relating to his own sense of physical well-being. In one sense, John's addiction process had been atypical of most of the physicians I've treated, since it had a more obvious and dramatic apparent triggering event and relatively short duration, and that gave me some hope that we could make some good progress right out of the gate by focusing on the specific traumatic events. 

    However, the events themselves, which were extremely violent, still clearly posed painful memories for John, and I was not sure if they were going to interfere with our being able to get at the underlying factors in why John chose to engage in on-the-job substance abuse rather than seek counseling (either professional or from family or co-workers). For that reason, at this point I wanted to spend not more than two more sessions at most on this particular topic. 

    One further note of interest was that John mentioned that he starting using "other stuff than the pills" after he spoke to the psych resident at his hospital, which seemed odd - until I learned later in the session that the resident in question had been due to examine the patient who later attacked John. Once again I think this illustrates the need for hospitals to encourage out-of-house counseling for personnel suffering workplace trauma... although I think you would agree, this is a rather extreme illustration of why it might be a good idea! 

    As for the followup noted, I never did receive a callback from Robert Romano at Cook County General, although I did speak initially to a Dr. Carrie Weaver who said she would give him the message, so... ? 

  


**5/30/00 session**

    _Notes: A somewhat clouded session - continued discussion about work place issues. J is clearly feeling some anger over intervention & how it was handled but could not offer thoughts on how his colleagues could have helped him more effectively. Said he feels he received adequate support from co-workers, but seemed somewhat ambivalent with this statement. Discussed the role of his supervisor, Dr. Green, in his entering the program. Venting. Discussed J's physical therapy and withdrawal symptoms._

    My comments: I had hoped to encourage John to feel more comfortable in expressing anger in this controlled environment, but I wondered if I had emphasized this part of the healing process too soon for a six-week program. I wanted to proceed with caution, as John clearly had many areas to discuss. I attempted to steer this session away from the actual intervention experience because, as you've said before, time is short and listening is expensive, and in my opinion his angry response to the intervention itself was fairly typical of addicts and not, in my opinion, directly relevant to his (many?) other issues. 

     I came prepared to talk in this session about Valentine's Day but this did not materialize, obviously. Also, it wasn't clear to me if Dr. Green was the person who brought him down here to be admitted to the program, who I understand was a fellow doctor on staff at Cook County General involved in the intervention. 

    Since John gave his approval for the taping of four sessions, I informed him at the start of this session that we would be commencing it at a later date, unless he wanted to start right away; he said no, which I suppose worked out for the best, since this session (though an important one for John) was not particularly of special interest compared to some of the later ones. 

  


**6/1/00 session**

    _Notes: Began with discussion of J's current daily physical therapy. Mobility returning but possibility of need for chronic pain mgmt. Presc pain meds discontinued, now on muscle relaxants. J reports no prior drug or alcohol misuse, and no history in immediate family except cousin - IV narc user. Cousin never received professional treatment - J initially very reluctant to discuss. Discussion of family reaction to cousin's problems. Extra 15 min._

    My comments: Yet again, I was forced to recall your stance on the absolute necessity of going the extra mile and taking as complete a family "drug history" as possible: parents and siblings are not enough! Fortunately, John made it easier for me to correct my mistake by seeming obviously unsettled by this line of discussion -- enough so that I was able to gently probe around the edges and get him to open up about his cousin, Chase, a heroin addict whom John had been supporting in his efforts to detox outside of treatment. Chase overdosed some time later and suffered permanent brain damage. Clearly, this was a major issue in John's own attitudes toward his addiction which had to come up sooner or later. 

    John could not recall the exact date when he began considering using "something else" besides his prescribed medication in order to deal with his chronic back pain, but acknowledged that these were impulses that he, normally open with friends and family, would never have shared -- despite having heard about and met other doctors at his facility who had struggled with drug and alcohol problems. This he was quick in linking back to his experiences with Chase, one of many cousins with whom he was quite close. Chase's relapse was traumatic for John and not only led to an extended falling-out with his family, but also to a sense of personal and professional shame and failure. It was an incident he rarely discussed with co-workers and "of course, never with my grandmother" with whom he had the most contact because of his parents' frequent business trips over the years. (Ironically, just before his own narcotic abuse began this spring, he had reconciled with his grandparents for the first time since Chase's addiction and hospitalization two years ago.) 

    As it turned out, however, it wasn't until a co-worker chose to talk to John about Chase that John agreed to enroll in our program. (I learned that this was John's former teacher, Dr. Peter Benton, who was also the person who had accompanied him here originally.) John was thankful that someone had done this. About the possibility of a connection between his experiences with Chase and his own drug usage, he said, "I knew, but I didn't want to know." 

    This was a productive session, and as you can see, we ran a little overtime. I know this is something you've strongly discouraged in the past, but I felt it was necessary to cover the extra ground, and that it did not unduly compromise professionalism. 

**Partial transcript, 6/1/00 session**

Legend: **T** = therapist, **P = patient **

> **T**: How old was Chase when this happened? 
> 
> **P**: He was 23. He's three years younger than me. 
> 
> **T**: How old was Lucy? 
> 
> **P**: ... I think she turned 23 in January. Yeah. 
> 
> **T**: You've lost some young people who have been pretty close to you. Chase, Lucy. Your brother. 
> 
> **P**: But I work in an emergency department and you get used to it... Well, you never get used to it, but you do see it nearly every day. You know, kids die, old people... just the same. 
> 
> **T**: I would imagine it's different, though, when it's a young person that you know. 
> 
> **P**: ... Sure. But Chase, he -- he wasn't a kid. I mean, I've already accepted that it was his choice to do what he did. I tried to help him, but... 
> 
> **T**: You said that you had kept his problem away from your grandparents. 
> 
> **P**: I know. That was a mistake. It was wrong of me to try and help him on my own. I wasn't good enough. Now, I didn't cause what happened, but I know it was a mistake. 
> 
> **T**: If you _were_ good enough... what do you think might have happened instead? 
> 
> **P**: ... I don't know. I wanted him to get clean. I wanted my grandparents not involved. But they got involved anyway, and they were furious, and they were right. I didn't know what I was doing and I needed them. But I wanted to do this for them. ... After February... my grandmother, she was trying to help me. It would have killed her to know what I was doing, but I just didn't want to lay that on her. But I wasn't strong enough to take care of myself. 
> 
> **T**: That's a lot of pressure to put on yourself. Being good enough, strong enough. 
> 
> **P**: I know. I don't know why I do that. I like helping people, but I guess I don't want them helping me. 
> 
> **T**: Your teacher helped you. 
> 
> **P**: Yeah, well... [_laughter_]... um... not after I punched him out first actually. 
> 
> **T**: You punched him out? 
> 
> **P**: I was all screwed up. It was after they dragged me into the exam room and ganged up on me. I was mad. I guess I shouldn't have been. I just lost control. He told me how I messed up with Chase, and I got so angry... I hit him in the face. 
> 
> **T**: What did he say to you exactly? 
> 
> **P**: I don't remember. I don't know. Maybe he didn't say that... I was way, way out of line with him. He was right. ... He's always right. 

  


**6/7/00 session**

    _Notes: Need to complete RTWI by the 17th. Discussion of on-the-job relationships naturally moves to J's relationship to Dr. Benton, primary teacher & supervisor for 1st 3 yrs at CCG. J originally had surgical internship w/Benton, decided to switch to emergency med, this decision became source of conflict. Liked surgery but felt uncomfortable with the culture. J had wanted to return to one-on-one patient relations more typical of the ER. Still felt loss at change. Expressed frustration at abrupt end to working partnership. J seems more open, less guarded this session._

    My comments: Since we were coming to the point where we needed to complete John's Return-to-Work Inventory, I allowed John to take as much time as he needed this session to discuss any impressions or concerns he might have had about the possible reactions of his co-workers to his planned return to work. As it turned out, our conversation in this session focused almost exclusively on John's relationship with his former teacher, Dr. Peter Benton. Dr. Benton had played a key role in the intervention which was staged for John in May, although he had not actually worked closely with him since John left his surgical residency in 1997. 

    John seemed to need to talk about his surgical residency at some length. Throughout our earlier sessions, John had seemed emotionally detached from his colleagues (although this seemed to be due to issues he had with the intervention itself), but this attitude did not appear to extend to Dr. Benton. His prior association with Dr. Benton was something of which he seemed quite proud. Although he admitted to me that his professional relationship with Dr. Benton was often adversarial due to a clash of styles (and that "we have no personal relationship to speak of"), he wondered if "all this never would have happened if I was still up there with him" and had not switched specialties in the first year of his residency. This decision, John felt, had been not entirely the result of his personal career ambitions, but also as a result of a particularly difficult and pressure-filled period during which a friend and fellow intern on their surgical team had unexpectedly committed suicide. (Ironically, an event for which John had received brief counseling on behalf of CCG's surgical department -- an option which was apparently never offered him by his current supervisor). 

    John expressed guilt feelings over Dr. Benton's role in his intervention. John had felt unable to work further with his teacher after the suicide incident, partly due to resentment of Benton's teaching methods, and partly due to other, extenuating factors. However, he was concerned that the revelation of his drug problems to the senior staff had been an embarrassment and a letdown to Dr. Benton ("He couldn't even look at me"). I asked John how things might have been different, vis a vis his problems of this year, if he were still working on the surgical wards with Dr. Benton. "I would have been a better listener, a better teacher," he answered immediately. John highly respected Dr. Benton's teaching methods and felt that he had time and again approached him the wrong way, trying to impress him by learning surgical procedures, "but never what I needed to learn from him in order to teach a med student...somehow, I was listening the wrong way." John continued by expressing regret over his (self-termed) "ineptitude" with his own students, including Lucy, the student who died after the attack in the emergency room. He concluded, in answer to my question, that one way or another, Lucy would still be alive if he had never left Dr. Benton. 

    This insight offered by John into this relationship was valuable, but as he seemed to be rapidly falling into a nonproductive, negative cycle of "what-ifs" and self-criticism, I tried to steer the discussion toward what he expected his relationship with Dr. Benton to be like once he returned to work. Did he anticipate any major changes? John thought not, although he hoped to have the opportunity to sit down with his former teacher and "say how very sorry I am." 

  


**Partial transcript, 6/7/00 session**

> **T**: Do you think there were any other areas of conflict with Dr. Benton? Professional, personal? 
> 
> **P**: There was... when we were working with Dr. Keaton on a pediatrics rotation that fall... Abby... 
> 
> **T**: Abby Keaton, yes, I think I've heard of her. 
> 
> **P**: ... Well, it's a little... [inaudible] ... I was involved with her. 
> 
> **T**: M-hm. 
> 
> **P**: [inaudible] 
> 
> **T**: I'm sorry? 
> 
> **P**: I can't help wondering if she was just using me. 
> 
> **T**: Do you mean, for a sexual relationship? 
> 
> **P**: No, I mean... every once in a while I just get the feeling that I wasn't the first intern she slept with, like, I was just the latest in a long string. 
> 
> **T**: You feel that she took advantage of her interns? 
> 
> **P**: No! She is not like that. ... I don't know... I never heard anything but there was just something about her... Don't get me wrong, she is a great lady, but people are very respectful of her, she has a lot of authority... Even Dr. Benton was in awe of her. I'm wondering... maybe everyone knows about her, but nobody thinks they should talk about it. ... I was pretty crazy about her, but see, she's the one who made the first move on me, you know? It's like she knew what she was doing. ... Look, I know what you're thinking, but she was always very ethical, she didn't want to mix our work with... that. 
> 
> **T**: I have to be honest here and say that to me, you don't sound entirely convinced. 
> 
> **P**: ... You know, it was sort of exciting, but it got me so stressed out after a while, trying to keep it a secret. To her it was just no big deal. I don't know. ... But you know, who am I to complain about keeping secrets. Me, of all people. 

  


**6/9/00 session**

    _Notes: Picking up from previous session: J discussing relationships with women - AK & recent partner w/mastectomy. J has not troubled with his relationships but admits they are usu unstable & short term. Wonders if this has any connection with drug usage? With poss exception of AK, J states he feels in control of these relationships, sees them as positive if not completely satisfying. _

    My comments: Throughout this session, I noticed that John seemed somewhat anxious to frame our discussions purely in the context of his drug usage. I began to get the sense that John was overanalyzing things a bit. (At one point, a look of sincere alarm crossed his face as he said, in all seriousness, "Could it be that I am also addicted to women who have blonde hair?") Although I was finding this patient's intelligence and talent for self-examination a delight, I also kept in mind your past admonishments to me not to let the patient run away with a session. 

    But as (unintentionally) amusing as John's momentary worry about women was, it also confirmed for me that he perhaps had now finally accepted himself as an addict, and was now more fully owning his problem. Considering that only a few sessions earlier he had repeatedly glossed over the subject of his fentanyl use, this was a welcome development. 

    I wanted to explore John's feelings about others' opinions (real or imagined) about his various relationships. This included more discussion of his relationship with Dr. Keaton and other women. John pointed out that in general he enjoyed the company of women older and "more mature than me" and seemed happy, almost proud, of the fact that this was true of his most recent girlfriend (who also happened to be related to his family by marriage.) It was at this point that I realized that John tended to talk about these women in the present tense, even though in each case they had broken off the relationships abruptly for various reasons, and in fact were no longer in the country. Did he expect any of these relationships to resume at some point in the future? John responded that he had "never really thought about it; I just assume I will see them again sometime." This type of vague answer was in marked contrast to the confident earlier statements he'd made in the session about "feeling in control" of the relationships. 

    It occurred to me that John perhaps had a tendency to deny and minimize not only the importance of certain relationships in his life, but also that he typically had real trouble acknowledging their transformations, and moving on. (This also seemed true, to a lesser extent, with his relationship with his teacher, Dr. Benton.) Denial and minimization, of course, are the most useful attitudes for keeping a doctor on an addictive path. But was there a key relationship in John's life which we could use to constructively confront this? And how could I identify it? It seemed to me that we had a lot of work ahead of us in this area, and in a rapidly dwindling time frame. 

  


**6/16/00 session**

    _Notes: J edgy and subdued, commenting on end of program in 2 wks. Feels he has not made much progress. Completion of RTWI and discussion of his arrangements for reintegration into work environment. Was contacted by CCG earlier this week with a date for hospital board hearing on his case, Aug. 9. Suggested he contact Jamal Williams of the AMA with concerns about any legalities regarding his legal options re CCG. _

    Followups: Consult w/Dr. F about John's current medications. 

    My comments: After taking twenty minutes for John to complete the Return-to-Work Inventory (I chose not to administer questions 8 and 9, since John was already in a course of physical therapy and these items seemed redundant, not to mention time-consuming), our conversation in this session had trouble getting started. Somehow, despite numerous breakthroughs over the past few sessions, I sensed that this patient's basically bright, optimistic attitude toward his recovery had taken a subtle turn toward negativity and self-hatred. The day previous, he had received notification that he would have to face a board hearing after all, and this was the most obvious event that had seemed to throw him off balance. There were no obvious outbursts - rather, he tended to act a little silly in this session - but his engagement in his recovery seemed to be flagging. I couldn't be sure if it was because of a physical cause, or because he knew he was getting closer to having to return to work, or that we had left some crucial issue unexplored. 

    I felt similarly at loose ends once we'd completed the Inventory, so I suggested that John should, on his own time, write letters to some of his co-workers (without necessarily actually sending them), getting off his chest whatever he felt was appropriate, or even inappropriate. I know that you generally only recommend this type of exercise for victims of family violence, and that you've called it a desperate "amateur" method. But I saw it as perhaps my only way to create further, focused discussion on John's personal relationships that might possibly give me a better bearing on how to highlight his denial/minimization habits in a meaningful way that would stick. I suggested that John write personal letters to any co-workers in his department who he was feeling might not respond to his return to the ED in the way he would like. John immediately mentioned Abby, the medical student who had reported him to his supervisor, remarking that he wasn't sure how he was going to face her. They had had a smooth working relationship, but shortly before the intervention meeting, he had accused her in front of their supervisors of fabricating her account of seeing him injecting fentanyl in a treatment room. 

**Partial transcript, 6/16/00**

> **P**: ...Whoops. I missed. Don't worry, I'll pick it up. 
> 
> **T**: We can't all be Michael Jordan. 
> 
> **P**: But we have a hoop right outside. Right outside the ambulance bay. I do play. I used to be good... I used to be very, very good. 
> 
> **T**: Just layups, or have you guys got a team? 
> 
> **P**: No... no team. There are pickup games. We have our fun whenever we get the chance. Pickup games, baby showers... and of course, Valentine's Day parties... Just one big happy family. 
> 
> **T**: Does Dr. Benton play? 
> 
> **P**: ...No. Never. 
> 
> **T**: Do you want him to? 
> 
> **P**: I don't know. Should I put that in the letter? 
> 
> **T**: You put whatever you want in there. That's the point. Instead of talking to me, you talk to him, or to anyone else at Cook County. 
> 
> **P**: And then what, you spell check them at the next session? 
> 
> **T**: No, no. This is strictly an exercise for your benefit. You do not have to show me what you write. Or anyone else. You can throw them out or burn them, it's totally up to you. But it can be a good thing to do, for yourself. 
> 
> **P**: ...Can I write to anybody I want? 
> 
> **T**: Well... it's actually more useful if you write to someone you actually know personally. Like, don't write to the President, because we'd probably have to have you committed, and then we'd have our federal funding cut off. 
> 
> **P**: [_laughter_] Okay. It seems kind of weird though. ... Anyone? 
> 
> **T**: Anyone. It's okay. 

  


  


_Dear Mom and Dad, _

How is Japan this time of year? I know it's been a long time since I last wrote. How was the weather in Singapore? I haven't forgotten about your invitation to stay at the summer house. There's something I really need to say: Dad, you need to get a new secretary at the office in Singapore. I can barely understand her and I think the feeling is mutual. I don't think she is giving you your messages. Can you fire her, or did she come with the furniture? Mom, when are you going to start using your e-mail? 

I really do want to come up to the summer house but I have been so busy working. I am walking a lot better now and doing a lot more. I'm also now the residents' rep on the Emergency Services Committee. When I get back from this break and get this all cleared up, I want to have you come by to the hospital and finally take the tour. Let's have lunch at the club with Gamma. 

Have a safe trip back. I love you both. Let's 

  


  


**6/21/00 session (unscheduled)**

    _No notes taken._

    My comments: This was a very emotional session for John, with a lot of anger and sadness. The letter-writing exercise had proven to be very useful indeed, although I am not sure if he completed the letters to his colleagues which had been suggested. He only seemed interested in discussing his feelings about the one to his parents (which he brought along with him and called "pathetic," a term which later in the session he would apply to himself). 

    John insisted that I keep the letter for my students to see along with the transcripts. (Of course, I can't do this because it wasn't included in the release form, but I don't feel it is a violation of his confidentiality to include it with these materials for your eyes only, since he did ask.) At one point discussing his letter, he became very agitated and distraught, and insisted forcefully and repeatedly that I call his parents (who were overseas) and "make them come here right now...or else I am leaving." 

    This demand of John's stopped any productive discussion cold for a few minutes, but eventually he became more focused after I asked him to think about other times he might have wanted his parents to respond more quickly to his emotional needs. This led to a (much more measured) discussion about John's older brother, Bobby, who died of leukemia when John was around eight. John recalled the death and his own feelings of abandonment by his parents during Bobby's illness. We also talked about how this experience affected his choice of career. John felt, upon reflection, that his "super doc" tendencies and attention-seeking behavior could be relevant to a need to gain emotional nurturing from his parents at that particular time in his life. 

    Although this last realization seemed to be an immediate breakthrough for John, he then expressed a great deal of sadness over his imaginings of his parents' own traumatic reactions to the death of Bobby, particularly those of his father. This was the first time, he said, that he had considered their possible point of view. They had never cried in front of him, not even at the funeral. He also commented that in light of this, he was now no longer surprised that they never seemed to support his medical career, because "the hospital is where they lost their son, and where they lost their hope too." John also recalled that he had chosen to stay with a critically ill patient on the day he graduated from medical school, missing a chance to be with his parents at the ceremony ("Another kid who suddenly wasn't there"). This memory was now very upsetting to him. 

    By the end of this impromptu session, John reiterated strongly that he loved his career as a doctor, but expressed uncertainty that he would be able to reconcile this with his need to address the newly sensed issues in his relationship with his parents. We discussed the possibility that there might be little he could do to dramatically change his father's behavior, as far as personal visits to the hospital and outwardly expressed attitudes about his medical career. However, I encouraged him to retry the letter writing exercise on his own, and suggested he might consider keeping a personal journal when he returns to work. 

  


  


**Partial transcript, 6/30/00**

> **P**: It seems weird that I, uh, I won't be coming back here next week. ... I am going to really miss those back massages at the pain clinic at Georgia Tech. 
> 
> **T**: You must have had Pamela. 
> 
> **P**: Yeah, how did you know. 
> 
> **T**: She's great. I gave her up for Lent once. So you are going home... Wednesday, right? 
> 
> **P**: Right. ... I just want to thank you for seeing me that night when I called. This was good. I feel better. ... Actually to be honest, I don't feel better, I feel like crap, but it's real crap, and not fake being OK. 
> 
> **T**: So how are you, John? 
> 
> **P**: Well, I am not fine, but I am OK today. 
> 
> **T**: Sounds good to me. By the way, thank you for agreeing to let us tape you. 
> 
> **P**: Sure. So you think I'm an interesting case? 
> 
> **T**: All my cases are interesting. 
> 
> **P**: Nah, I'm not interesting... I was just ... back where I work, I'm just as crazy as the next resident. We're all... pretty nuts. 
> 
> **T**: ... Listen, before I forget, I wanted to tell you that if you are interested in the future, we would love to have you down here for our yearly retreat. It's conducted by our own Dr. Burton, who just does a ... fantastic work ... We have doctors who have been through the program come back and talk to doctors who are going through the process, you know, answer their questions. 
> 
> **P**: Sure. ... What if I'm not well by then? Would you still want me? 
> 
> **T**: Well, Dr. Burton likes to say that wellness is a journey, not a destination. ... So, anytime you want to come back, John, we would love to see you again? 
> 
> **P**: ... I can't make any promises. 
> 
> **T**: Well, that's an honest answer. 
> 
> **P**: You know, that's the best thing anyone's said to me since I've been here. I need to be more honest. I want to be. 
> 
> **T**: We all have to start somewhere. ... Good luck to you, John. 
> 
> **P**: Thanks. You too. 
> 
> **T**: Have a safe trip home, and take care of yourself. 

  


**Summary**

    Dr. John Carter successfully completed the 45-day Physician Diversion Program on July 6, 2000. Dr. Mark Greene, attending physician of the Cook County General Emergency Department, has agreed to be John's weekly staff contact for the first six months of his return to work, and has been sent our informational packet. It is my understanding that John plans to continue with physical therapy and/or a pain management program immediately upon returning home. 

    Although John probably will continue to work in a high-pressure emergency medicine setting and will sooner or later need to work again with narcotics, I feel confident that the chance of relapse with this subject is relatively low. I think you will agree with me, upon review of these materials, that John has attained a firm grasp of the nature of his addictive behaviors and has appeared to accept that he will always be at some risk. He has expressed a desire to seek permanent changes in his lifestyle and interpersonal relationships both on and off the job. 

    I'm proposing to write up this case for consideration for the Journal's upcoming issue on drug dependency among physicians (Autumn 2001). While this case does not appear to embody any current "trends" in the latest national reports on doctors and addiction, I feel that an in-depth exploration of this subject's personal road to addiction and recovery can make a worthwhile piece for the Journal, especially where this case seems to illustrate the need for post-traumatic counseling and stronger interpersonal bonds among hospital staff. All too often, the professional and emotional needs of junior staff members "fall through the cracks." It is sometimes necessary to reacquaint administrators and senior staff with the potential damage to and disillusionment of talented, dedicated young health professionals when their unique needs are ignored. 

    If you have any questions about this project, please let me know when I may come up and see you. 

_G. Porter_

  


  



End file.
